Hampshire and Isle of Wight Healthcare NHS Foundation Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated effective as requires improvement. At this assessment the rating has been changed to good.

Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. We looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

There was a pre-admission assessment completed for all patients. Care plans were updated within 72 hours of admission. An assessment of a patient covered their mental health, physical health, social circumstances, and support needs.The trust had a clear process from referral through to admission. This is supported by the Cambio Process with oversight through the Provider Collaborative Clinical Activity Panel. The Cambio Patient Flow Manager (PFM) process within the NHS is a digital system designed to streamline patient referrals, assessments, and bed management. This is an important stage of the referral processes as the system checks that the patients do meet secure environment requirements and determines the level of security, supporting the least restrictive practice.

All accepted referrals then have a detailed nursing assessment. Patients are then supported with a transition into the relevant unit.

The first 12 weeks provides the MDT to undertake a thorough assessment and formalize the HCR-20 and HONOS-Secure.

We reviewed 21 patients’ care and treatment records. Staff completed a comprehensive mental health assessment of each patient either on admission or within 72 hrs of admission. Patients’ physical health was monitored daily or more often according to the patient’s needs. This was an issue from the previous inspection and we found in this assessment that the wards had introduced effective electronic NEWS2 monitoring using a system which worked on electronic devices. We found this was being used effectively on most wards and was having a positive impact on patient physical health monitoring.

Psychologists based the patient’s treatment pathways on best practice guidelines, including psychological therapies. Medical staff used best practice to inform their treatment pathways for managing patients with severe trauma, self-harm, anxiety, depression, substance misuse and sexual offending.

Patients had their physical health assessed regularly during their time on the wards. On most wards staff developed a comprehensive care plan for each patient that met their mental and physical health needs. However, at Bluebird house, the quality of care plans varied between the two wards for example there was a diabetic care plan on starling ward that did not explain what to do in an emergency. Care plans were personalised, and there was evidence that the care plans contained the patient’s voice.

Care plans showed that where patients needed a referral to other health professionals this was completed, and staff supported patients to attend appointments.The forensic/secure services use the CPA process, which they are commissioned to do. Patients who have autism or an LD will also fall under the CTR (Care and Treatment Review) process. For CAMHs this also includes review of their education.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice

Staff followed evidence-based good practice and standards. Patients received appropriate therapeutic, drug and physical health monitoring. Patients had access to a broad range of psychological therapies.

However, patients in Ravenswood House said there was not a lot of ward activities, in the evenings and at weekends, and that they were sometimes bored. Staff showed us a range of board games that they played with patients at the weekends, but they did not always have the time to carry these out due to managing the ward environment. Staff said there were suitable numbers of occupational therapy staff during the week but they were not available at the weekends. Activities included, access to a therapeutic space called the ‘Crows Nest’, table tennis, pool, gym, video games, football, gardening, walks and cooking.

The wards had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, there were occupational therapists, clinical psychologists, social workers, pharmacists, speech and language therapists and dieticians.

Managers provided new staff with appropriate induction (using the care certificate standards as the benchmark for healthcare assistants).

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. Managers ensured that staff had access to regular team meetings and ward staff were having regular supervision and appraisals in line with the trust guidance.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Patients felt that staff listened to them and knew what their needs were. Patients attended their multidisciplinary team meeting to discuss their care with all the staff involved. Staff clearly shared information with patients about their care and when it was appropriate details of moving between services. Carers felt that communication with the multidisciplinary teams was positive and they were well supported with their loved ones.

The ward teams worked effectively together and across services to support people. Each ward had a multidisciplinary team (MDT) meeting once a week. Patients, nursing staff, doctors, occupational therapists and psychologists attended these meetings. Nursing staff felt that their voices were heard in the MDT. Staff felt that teams and services worked well together, including advocacy and the social worker. Nursing staff handed over after each shift and discussed vital health and risk information.

Staff on the ward met every month to discuss business continuity and complex cases. Minutes for patient ward rounds showed that staff were discussing patient risk, their care plan including physical health information and input from the patient and their loved one or carer where appropriate.

Staff held regular multidisciplinary meetings to discuss patients and improve their care. The consultant psychiatrists held a weekly ward round, which consisted of nursing staff, ward doctors and therapists. These meetings reviewed the patients’ care and treatment including risk, recovery goals, capacity and medicines.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Patients said they were able to go outside into the grounds and when their agreed status under the Mental Health Act allowed, they were able to access the community. Patients and staff at Ravenswood House were unsure about how access to the community was going to be affected by the recent closure of an important bus route that went from outside the hospital. This was a concern as the Hospital was in a rural location and access was difficult without public transport links. The Hospital senior leadership team had plans in place to support patients’ community access and were continuing to have discussions with the local bus company and local council to see what could be agreed. Patients said they could access the grounds when it had been risk assessed.

Patients across the services said they could make hot drinks and snacks 24/7, they said they had their own kitchen access on the wards. Patients had the opportunity, subject to clinical appropriateness, section status and risk assessment, to do their own shopping.Each unit had an internal shop and banking system

Staff supported patients to access the local leisure amenities in the community and at the onsite gym. Staff supported patients to quit smoking by supplying nicotine replacement therapies.

There was regular access to a GP clinic and dentist so that patients who were not able to access the community due to their restrictions under the Mental Health Act could still access physical healthcare services.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff continuously monitored patients’ health, their mental state and well-being. At twice daily handover meetings, staff noted details of patients’ sleep, food and fluid intake, personal hygiene, compliance with medication, and engagement in activities. Any changes in a patient’s presentation were discussed at the daily multidisciplinary team handover meetings.Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes. For example, doctors used the Global Assessment of Progress to measure patients progress and outcomes. The Glasgow Antipsychotic Side-Effects Scale (GASS) was used to measure any adverse effects of medicines. The services also use HCR-20 and HONOS-Secure, when appropriate to the patient group.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff assessed each patient’s capacity to consent to admission and treatment on admission. Capacity was monitored and recorded at multidisciplinary team meetings. Records showed that these assessments covered the four elements of capacity.

If a patient was detained under the Mental Health Act 1983, the arrangements for their detention and treatment were consistent with the requirements of the Act and accompanying code of practice. Staff supported patients to understand how the Mental Health Act applied to their situation and that patients understood their right to appeal.

When staff felt a patient may have lacked capacity to make a decision, staff provided support. For example, if a patient was thought to lack capacity to consent to treatment, staff explained why the treatment was important, how they would benefit from it and described any possible side-effects.

Staff engaged with patients’ families to understand each patient’s history and interests.